High blood pressure (hypertension) is the leading cause of death globally and the most important modifiable risk factor for cardiovascular disease. The recent release of the 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults from the panel members appointed to the Eighth Joint National Committee (JNC 8) represents a much needed update for the management of ideal blood pressure in a variety of individuals based on age (18 years or older) and underlying medical condition (diabetes, chronic kidney disease [CKD], etc.).
What are the Important Questions?
#1 – When should a blood pressure medication be started?
#2 – Should blood pressure be treated and lowered to a specific target?
#3 – What is the best blood pressure medication?
It was determined that the threshold for starting a blood pressure medication (Question #1) and the specific target for an ideal blood pressure (Question #2) should be the same.
What are the Recommendations?
When to Start a Blood Pressure Medication and the Specific Treatment Target
1. 60 years old or older:
- start treatment at a systolic (“top” number) or diastolic (“bottom” number) blood pressure of ≥150 / ≥90 mm Hg
- treat to a blood pressure of <150 / <90 mm Hg
2. Younger than 60 years old:
- start treatment at a systolic (“top” number) or diastolic (“bottom” number) blood pressure of ≥140 / ≥90 mm Hg
- treat to a blood pressure of <140 / <90 mm Hg
3. 18 years old or older with diabetes or chronic kidney disease (CKD):
- start treatment at a systolic (“top” number) or diastolic (“bottom” number) blood pressure of ≥140 / ≥90 mm Hg
- treat to a blood pressure of <140 / <90 mm Hg
Preferred Initial Blood Pressure Medications (see medication list below*)
4. General non-black population:
- a thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB)
- combining both an ACEI and ARB is discouraged
5. General black population:
- a thiazide-type diuretic or calcium channel blocker (CCB)
6. 18 years or older with chronic kidney disease (CKD) or diabetes:
- an ACEI or ARB to improve kidney function
*Thiazide-type diuretics
Chlorthalidone
Hydrochlorothiazide
Bendroflumethiazide
Indapamide
*Calcium channel blockers (CCBs)
Amlodipine
Nifedipine
Diltiazem extended release
Nitrendipine
*ACE inhibitors (ACEIs)
Benazepril
Lisinopril
Enalapril
Captopril
*Angiotensin receptor blockers (ARBs)
Losartan
Valsartan
Irbesartan
Candesartan
Eprosartan
Long-term Goal of High Blood Pressure Management
7. The purpose of high blood pressure treatment is to attain and maintain an ideal blood pressure:
- if ideal blood pressure is not reached within a month of treatment, the dose of the initial medication should be increased to the maximum dose and/or a second medication class should be added
- if ideal blood pressure cannot be reached with 2 medications at maximal doses, a third medication class should be added
- if ideal blood pressure cannot be reached using more than 3 different classes of medications at maximal doses, then a referral to a hypertension specialist may be indicated
What is the Controversy?
The most controversial recommendations were loosening the threshold for starting a blood pressure medication in those aged 60 years and older to a systolic blood pressure (“top” number) of ≥150 mm Hg, instead of ≥140 mm Hg, and ≥140 mm Hg for those with diabetes and chronic kidney disease (CKD), instead of ≥130 mm Hg, as per previous recommendations. Multiple studies since these new recommendations have suggested worse outcomes in both cases, which is obviously concerning. Additionally, a recent study in people with type 2 diabetes showed that they are less likely to suffer from heart attacks, strokes, or early death when they take blood pressure medications—even if they don’t have high blood pressure!
Unfortunately, there is a lack of high-quality medical evidence for ideal blood pressure goals in those aged 60 years and older and many people disagree with the new recommendations. People argue that this small increase in ideal blood pressure goals may potentially increase cardiovascular disease rates in older people and result in a greater healthcare burden. However, the authors of the 2014 guidelines firmly believe, based on the current evidence, setting a goal blood pressure of <140 mm Hg in this age group provides no additional benefit and recent evidence suggests that implementation of the 2014 guidelines would be cost-effective and save lives.
What You Need To Know
1. If you are 60 years old or older without diabetes or chronic kidney disease (CKD), then your ideal blood pressure should be <150 / <90 mm Hg with or without blood pressure medications.
2. If you are under the age of 60 years or have diabetes or chronic kidney disease (CKD), then your ideal blood pressure should be <140 / <90 mm Hg with or without blood pressure medications.
3. Should you need high blood pressure medications, your physician will decide which medication(s) are right for you.
4. Timely medical management of an ideal blood pressure and follow-up within six weeks is needed to prevent risk of cardiovascular events or death.
Decisions about ideal blood pressure management should carefully consider and incorporate all the characteristics and circumstances of each individual person. For all people with high blood pressure, the benefits of a healthy diet, regular exercise, weight control, and avoidance of tobacco products cannot be overemphasized. Take control of your health!
My blood.pressure has been 230-265/130-140 for a decade now. I don’t do doctors or take any medication except
COQ10. Here lately my heart feels “pinched” and I’m pretty sure I had a stroke a few months ago because I ended up on my back unable to get up and my entire right side was completely paralyzed. I got stuck like a turtle flipped over on its shell for about four hours b4 I finally made it back up on my feet again. Within two hours after that, I had all the feeling back on my right side with the exception of my arm still feeling partially dead. I guess Im just kinda curious as to when I’m gonna actually die from this?! Any ideas? I’m 54, by the way. Not that it matters!!
Thank you for your comment, you have described a very serious medical issue that needs prompt attention. Very high blood pressure that goes unchecked for many years, such as yours, will have grave consequences in the future and you are experiencing some of that now. If left untreated, your risk of death will probably be ~50% over the next 10 years (i.e. 50/50 chance of being alive in 10 years). You are young, 54 is not old, so you desperately need to take control of your health. High blood pressure is simple and easy to manage and you can prolong your life significantly. I recommend you find a primary care physician or emergency room to get your condition evaluated fully as soon as possible.
I have a comment on the “high blood pressure is easy to manage”. No, it’s not for some people. My mother was 51 or 52 I think when she had a slight stroke in the middle of the night and woke up with her left side of her body feeling numb. HBP runs in my family on my mothers side. For years she went to doctors who promised to get hers down and it stayed high 190’s or 200’s for years and the doctors never could get it down. So she went to different ones with a promise too and it never helped her. She finally went to one who ran dyes in her kidney’s and they saw a blockage on her left side and they put a stint in it. That lowered her BP significantly from what it was for years at the time. It went back to though but never quite as high as it was but still pretty high. Eventually she was diagnosed with chronic kidney disease and had to go on dialysis. Point is, doctors can promise to do things but every one is different and HBP isn’t always manageable. My mother has stumped lots of doctors because of all the different medications over the years and it’s been a lot of medications she has taken on at one time. They should’ve checked her kidneys a long time ago with dye or something but they didn’t.
At expert centers, when blood pressure is not controlled using three different classes of blood pressure medications (so-called “resistant” hypertension) then a secondary work-up for hypertension is completed. This secondary work-up includes an ultrasound of the renal (kidney) arteries that would have detected the blockage in your mother’s renal artery. When patients with resistant hypertension are managed at expert centers, their blood pressure can be easily evaluated and managed.
At last have found a Doctor (Spanish) who has suggested my husband cut down the drug Nicorandel by half to 20mg a day. Nicorandil is a vasodilatory drug used to treat angina. The reason is because his blood pressure, since we have followed the Ornish system for reversing CVD (three years) went down below normal and now we have moved to Spain, where the weather is much warmer, it has gone hypo! Prior to seeing this doctor my husband took his bp twice a day for two weeks, the diastolic pressure is consistently, even now (5 days after less Nicoraldil), below 60 and as low as 52. We have not told this doctor that we follow the Ornish regime as that information has not been well received by any medical person in Spain or France (where we lived before moving here) up to now. The French medical staff and one private heart ‘specialist’ in spain, take a dim view of patients trying to solve their own medical condition by dieting!
The lack of interest here in Europe for the dietary approach to CVD has been very disheartening because we cannot discuss progress with a medical professional or get a test done to see whether my husbands arteries are less blocked now than before. So, we have to make decisions on our own which I would rather not do but needs must! After my husband has seen a heart specialist here, (we only moved to spain a few months ago) and if he/she has the same bad opinion of dieting, I think we will just stick to the diet and slowly reduce the tablets to see what effect this has. At the moment my husband takes the following: MORNING: Nicorandil 20 mg, Bisoprolol 2.5 mg (beta blocker) reduced from 5mg, EVENING Zimvastatin 10mg. We cut that down from 40 mg after the bad press statins received. Pacemaker fitted. Any comments welcome. My husband does feel tired but when we go to the gym he can walk and do lifting, pulling and pushing weights for an hour with no problems.
It sounds like your husband is doing well. Since he has CVD, I would recommend a high-intensity statin, as he falls into the “Group 1” Statin Benefit Group (https://myheart.net/articles/high-blood-cholesterol-what-do-the-new-guidelines-say/). Otherwise, diet and exercise are some of the main components to heart health and longevity (https://myheart.net/articles/10-lifestyle-habits-of-super-heart-healthy-people/). Thank you very much for your comment!
I am a 73 year old male in Zambia, Indian origin, weight 55kg, height 168cm with good life style of 5 hrs per week of exercise, physically fit and healthy food habits, non-smoker, vegetarian (I take eggs), working as Professor in Physics at the University of Zambia.
My systolic BP is generally in the range 100-130, but the diastolic is in the range 50-60. I often feel dizziness, especially when getting up from a lying or sitting position. In winter I have cold intolerance, cold hands and feet. My ESR generally is high 35-100 for no apparent reason. I was advised to take more salt which I do to elevate the BP, but no effect. I sometimes feel drained energy and slowness in the brain.
I shall highly appreciate your guidance and advice on my e-mail.
Thank you very much.
I would say that your blood pressure is normal for your age. A wide pulse pressure can be seen with aging, due to stiffening of the large arteries from a loss of elasticity. Salt intake makes this phenomenon worse, so I would recommend not increasing your salt intake. The orthostatic intolerance that you are describing can also be associated with aging and compensatory physical maneuvers (i.e. countermeasures: immediate lying down or squatting, leg crossing, buttocks clenching, or fist clenching) are the recommended treatment.
Sounds like anemia, have your blood tested for iron deficiency, this is common with a vegetarian diet.
I am a healthy 72 year old male who exercises regularly, aerobic and weight training. I take an alpha blocker Terazosin for high blood pressure. My bood pressure averages 133/52, sometimes the diastolic drops to low 40’s. My resting heart rate averages 52bpm. I often feel tired and if I have nothing scheduled I can sleep 12-13 hours. While asleep my pulse is in low 40’s. I have been testing oxygen levels with an Oximeter and they average 95, after exersize like running or walking a round of golf Oxygen levels drop to 91-92. I suspect that my low pulse and low diastolic are causing my lowered Oxygen levels which may be causing me to be tired. My VA doctor had me take pulminary tests and the results were all OK. I have also been diagnosed with restless limb syndrome while sleeping. My FITBIT monitors my pulse and sleep patterns on sensitve setting and indicates I am awake 40% of the time while sleeping.
It is unlikely that your low pulse and low diastolic blood pressure are causing low oxygen levels, however, the low pulse and blood pressure could be causing you to be tired/fatigued. An important parameter to monitor would be what your pulse is when you exercise. If your pulse gets >100 beats per minute, then you have good chronotropic competence (i.e. heart rate response to exercise), which would mean your pulse is likely not the problem. Terazosin is not a good blood pressure medication. I would recommend an angiotensin-converting-enzyme inhibitor (e.g. benazepril) or an angiotensin II receptor blocker or a dihydropyridine calcium channel blocker (e.g. amlodipine). Potentially, a very good medication for you would be low-dose Lotrel (amlodipine/benazepril) but that would need to be discussed with your doctor. Overall, the first thing you should think about when someone has low oxygen levels and tiredness/fatigue is sleep apnea – especially since it seems that you might be restless while you sleep and not sleeping well. You should ask your doctor if a sleep study, to evaluate for sleep apnea, might be good for you. Thank you very much for your comment!
I know it’s been over a yr since you posted – replying anyway in case it might help others!
Have blood tests done to check for thyroid issues. One that’s not working properly can effect blood pressure with a myriad of hellish symptoms. If you get tested, I suggest a full panel to include antibody levels – I don’t remember the names – there are two of them. My tests revealed that I have hashimoto’s thyroiditis/hypothyroidism with a goiter. Then there’s hyperthyroidism which shares many same symptoms. Just a thought!
Yes, thyroid issues can cause blood pressure issues and is a very easy thing to test for. Thank you for your comment!
I am a 70 year old, blood pressure is 144/71. On ARB Meds. Tired, tingling in left foot. Is this normal
ARBs, and most hypertension medications, should not make you feel overly tired unless they significantly drop your blood pressure or heart rate. Numbness and tingling are an unlikely side effect of ARBs, so your symptoms are likely due to something else. If you continue to have symptoms, you should discuss them with your prescribing physician.
I am 67 years old and have been vegan for about 2 months, my blood pressure is around 110/77 when resting, is that to low for my age
No, that is not too low. However, if you are on medications to lower your blood pressure, then your physician can likely decrease some of your medications.
I am a T2DM patient last 15 years and on medications.My syst / diast BP at cardiologist, s office is 170/70.I am taking ARB(telmisartan 40mg) and CCB (clinidipine 10 mg) a day.Cardilogist here wants to take one more Beta Blocker(Bisoprolol 5 mg) one a day.Since I am diabetic and my sr creatinine is 1.4, is it ok for me to take betablocker and whether my blood sugar will rise.My fasting sugar is 140 and HB A1C is 7.1.
Your ideal blood pressure should definitely be <140 / <90 mm Hg with blood pressure medications. At this point with an ARB and CCB already prescribed, the next reasonable choice would be a diuretic or beta-blocker. Taking a beta-blocker should be fine under the guidance of your cardiologist. I would consider lowering your HgbA1c to ≤7.0% to reduce the incidence of microvascular disease and this can be achieved with a mean plasma glucose of ~8.3–8.9 mmol/L (~150–160 mg/dL). Ideally, fasting and premeal glucose should be maintained at <7.2 mmol/L (<130 mg/dL) and postprandial glucose at <10 mmol/L (<180 mg/dL).
Why do Dr’s in Canada still says Blood Pressure should be 120/80,
Surprisingly, blood pressure treatment targets and goals are still intensely debated. Additionally, there are differences in consensus statements and recommendations between the US, Canada, and Europe. There have been recent studies showing that both higher and lower blood pressure targets are better, depending on the patient population studied. Thus, patients and physicians around the world are left with individualizing blood pressure management for essentially each and every patient based on age and underlying comorbidities – as well as factoring in patient preference. That’s why you see various differences in hypertension management. Personally, I practice under the current JNC 8 guidelines as outlined in this post. However, the American Heart Association and American College of Cardiology are reportedly developing new hypertension guidelines that should be released in the near future.
I am an 80 year old man. I suffered with angina in the 1990’s and had a double heart bypass in 1996. Since then I have had excellent health, taking 2 Beta Adalat tablets a day ever since my Blood pressure always good averaging 128/73 for years. This year this medication was withdrawn and I am now on Felodipine. Since being on this medication I constantly feel as if my heart is going to burst through my chest although I am not doing anything strenuous and over the past 3 months that I have been on this medication my BP has risen to an average of 150/ 87 with highs as much as 168/103. My Gp doesn’t seem bothered about these readings, should I be?
I’m sorry that your blood pressure was well-controlled with one medication, now after changing medications, your blood pressure does not appear to be very well-controlled. Given your history of ischemic heart disease, your blood pressure should be at least less than 140 / 90 mm Hg. If your blood pressure is indeed greater than 160 / 100 mm Hg, that is unacceptable by most medical standards, regardless of your age or underlying comorbidities. You should have a discussion with your physician, if you are not satisfied, then you can always obtain a second opinion.
Thank you for this good information. I’d like to ask about the accuracy of Blood Pressure reading equipment. I have had a couple of blood pressure readings last year of 154/74 and 86 using those cheap white plastic cuffs ( I see them on Amazon for $10.00). In between these readings I have had the hand operated manual cuffs and they were significantly lower anywhere from 120/78 to 136/74. Do you hold a lot of faith in these cheaper cuffs? If so I would consider myself borderline for meds. I have no health issues otherwise. I am a 61 year old female.
Some cheaper equipment may have some issues. I would go by the measurements made in your doctor’s office, then correlate your measurements to theirs. The decision to start a medication should be based on quality measurements using reliable equipment.
My husband is 6’6″ 240 pounds and the doctor wants his blood pressure below 120/80 I feel concern for this because of his height..and because of proper diet it can go a lot lower..he’s 60 yrs
You did not mention his starting blood pressure, but if it was >150/90 mm Hg, then he needs to be started on a medication. I agree with you though, if diet and exercise changes begin to lower his blood pressure then some (if not all) his blood pressure medications could be reduced or discontinued. As far as a blood pressure goal moving forward, if your husband is without diabetes or chronic kidney disease his ideal blood pressure should be <150/90 mm Hg, but this may change in the future. A recent trial (Systolic Blood Pressure Intervention Trial [SPRINT]) suggested a lower systolic blood pressure goal of <120 mm Hg is better, but I would not go any lower than that (the average systolic blood pressure was 121.4 mm Hg, meaning more than half of the patients never even achieved <120 mm Hg). Ultimately the potential benefits of lowering blood pressure must be weighed against the harms. The benefits for each person must be discussed with your physician, so that the choice can be personalized.
Thank you for a most illuminating article. I am 82, have Marfan syndrome, a leaky aortic valve, and moderately distended aorta (but stable over the last few years). I have had at least 4 TIAs but none for about 5 yrs. I take Simvastatin 40mg/day, Clopidogrel 75mg/day, Doxazosin 2mg late in the day to try to depress evening BP, and Levothyroxine 175mcg/day (rather more than TSH would suggest, but I need it to feel well). I have severe breathlessness on exercise, and collapsed during a short walk the other morning. My BP (measured with a mercury manometer) tends to be very low in the mornings (60/40 to 90/60), but rises in the evenings to 120/60 to 160/65. My diastolic rarely rises above 60. It seems from reading this article that I have diastolic hypotension, but how can I treat it without pushing my systolic too high in the evenings? I have been advised to keep my systolic below 130 to avoid further damage to my aorta and valve – not quite practical at the moment. I always take a large drink of salty water every morning before rising, and I drink at least 6 pints throughout the day. I am in the UK.
Yes, this can be a difficult situation from a blood pressure standpoint. However, your systolic blood pressure is most important given your history of Marfan syndrome and dilated aorta. I would follow the blood pressure recommendations set forth by the physician monitoring your aorta.
You must be a very busy person so thank you for the time that you devote to answering these questions. I am a 67 year old slim male with a BP of 126/65. This seems high on the S side and low on the D side but according to your recommended numbers it’s all too low. The only thing that I have going on medically are very rare episodes of A Fib maybe once a year that don’t last very long. Should my BP be higher?
A blood pressure of 126/65 is within normal limits for you. A low blood pressure is only problem if it causes symptoms (e.g. lightheaded or dizzy when standing, extreme fatigue, pre-syncope or syncope, etc.), but I would not expect that from a blood pressure of 126/65. It sounds like you are exactly where you need to be, keep up the good work!
Hi I am a 37 year old male my bp rages from 130/80 to 145/84 form time to time but when I work out and jogg it’s goes to 127/84 so is it safe to jogging everyday to keep it low I don’t want to go to meds.
Also what should I do now to keep a healthy heart and bp before I get in my 50s .
Yes, exercise can lower your blood pressure and keep it low to prevent initiation of medications. You can follow the 10 Lifestyle Habits of Super Heart Healthy People here: https://myheart.net/articles/10-lifestyle-habits-of-super-heart-healthy-people/, in order to keep a healthy heart well past your 50s. Thank you very much for your question!
Thank you sir
O one more question for how long can a person maintain 140/80 is it something safe.
Technically, if you have no other medical problems, that blood pressure is acceptable indefinitely. However, I would suggest achieving a normal blood pressure (120/80 mm Hg) with lifestyle changes as much as possible.
Ok thanks sir
I had my blood pressure 132/90 in my initial measurement which a doctor arranged but another doctor measured it 130/80 after the first week ……I am 34 yrs old and a teacher by profession ….and recently got pain in the back of neck ……I daily exercise Yoga and other free hands …..Is my blood pressure normal ? Should I go for medication ? I am looking forward to an answer from you ….From India
Without any additional medical problems, 130/80 mmHg is fine for you at this time. However, I would suggest lifestyle changes to get your blood pressure closer to normal 120/80 mmHg. Reducing salt intake would probably be helpful for you, goal 2-4 grams a day. Thank you very much for your question!
Thank you for your unique article “isolated diastolic hypotention”. I am a 70 healthy male; but my diastolic is never higher than 60 while my systolic is averaged at 115. It is defined as widened pulse pressure. I swim everyday and have no medication. Shall I try to bring up my diastolic and how to without having my systolic also Raised? Thank you sir
Thank you for your kind words. If you have no medications, then there are not many options. I could suggest liberalizing your salt intake, but as a cardiologist, that is a difficult recommendation to make. I would recommend to continue what you are doing currently, and not worry too much about your isolated low diastolic blood pressure. Overall I think you are doing great with your health, congratulations!
I thought the previous article suggested lowering salt intake 4 low diastolic blood pressure due to elasticity issues in the coronary arteries maybe I miss read
Yes, lowering salt intake will reduce blood pressure and improve arterial vessel elasticity.
I am a 65 year old male being treated for hypertension with 25 mg chlorthalidone, 100 mg losartan, and 10 mg of amlodipine. My medicated BP has been around 116/72.
I recently lost 25 pounds and have been monitoring my BP at home and it has now dropped to 105/63 but the diastolic pressure is frequently in the upper 50s and the systolic pressure also had dropped below 100. One morning both were this low after getting up and nearly a day since I took my meds. I am not tired or light-headed, but are my hypertension meds driving my BP lower even if my weight loss had brought it down to a normal level? I do have CKD from having untreated hypertension throughout my 30s.
Yes, your blood pressure is likely lower because of your weight loss. This is a well-known phenomenon, and you should be congratulated! If your systolic blood pressure remains <110 mm Hg for several days/weeks in the setting of your ongoing weight loss, then you should discuss with your physician the possibility of decreasing some of your blood pressure medications. Thank you very much for your question!
I thought the previous article suggested lowering salt intake 4 low diastolic blood pressure due to elasticity issues in the coronary arteries maybe I miss read
I am a 63 yr old female. 5′ 1″ 108 to 110 lbs. My bp ranges around 90-105 / 58-60. I do 1 1/2 miles on an incline treadmill 6 days a week as well as another 1-2 miles walking my dogs daily and horseback riding 2 or 3 times a week. I feel good, but wonder if my bp is too low. It’s always been on the low side as far back as I can recall. Is it anything to be concerned about?
No, a low blood pressure can be normal for you. I assume you are not taking any antihypertensive medications, if so, then you should probably discuss with your physician about decreasing or discontinuing them.
My husband (age 30) has a BP in the 130s/80s on a regular basis. It does go up in medical settings, usually up to the 140s systolic. A few weeks ago it was up to 165 systolic at the doctor’s office, who immediately prescribed a low dose of metoprolol X2 per day. Since then his BP has been in the 120s/60s, but occasionally he has dizziness and his diastolic dips below 60. What would you reccommend?
Metoprolol would not be a first (or second or third) line medication for the treatment of hypertension. I would continue to check your blood pressure at home and only treat his blood pressure if the systolic blood pressure remains consistently >140 mm Hg (I am assuming at 30 years old, he does not have any other medical problems). I would not treat a one time high blood pressure reading without any additional confirmatory testing.
What does it mean when my Diastolic # is low and my Systolic # is high hear are some if my BP reading 132/68, 139/63, 136/71 126/69 is the delta between high and low suppose to be around 40, mine seem to push >60 I am a 63 year old male
Yes, the difference between your systolic blood pressure and diastolic blood pressure is your pulse pressure. You can have a narrow, normal, or wide pulse pressure for various different reasons. In your case, you have a wide pulse pressure, this is most likely due to aging and stiffening of your large arteries.
I am so grateful that give of yourself and your expertise to people with all these different problems. Thank you!
I am turning 82 on Sep.11th. I was just told that when the doctor took an EKG, that I have Afib. I was put on Xarelto 10 mg Tablets, and Metoprolol Tartrate 12.5 twice daily. Since I started, I feel awful. I’m so tired. Sometime I feel dizzy. I walk 3 miles in the am and 3 miles in the pm. I am a (half ) vegetarian, no red meat. I went for a second opinion and now awaiting several tests the new doctor prescribed. Meanwhile, I feel anxious and worry about what’s going on with my heart. I am taking Levothyroxine for years and don’t want to have to take blood thinners as well. I am appreciative for your input! Thank you,
I doubt it is the Xarelto making you feel awful, tired, and dizzy – although, you could switch to a different blood thinner (e.g. Eliquis or Pradaxa) to see if that improves your symptoms. It is most likely the metoprolol causing the symptoms you are experiencing, as long as your heart rate is controlled (<110 bpm at rest) then you may not need the metoprolol. Getting the standard blood work for newly detected AFib as well as a transthoracic echocardiogram would be very reasonable. Also reasonable would be to attempt a rhythm control strategy (i.e. getting you back into a sinus rhythm) due to newly detected AFib.
I am a 69 year old male that had a stent placed in my LAD artery in January. Rx treatments with Brilinta, atorvastatin and amlodipine @ 5mg were initiated afterwards. Resting BP’s prior to stent placement were averaging 135/70 and now are 10-15 lower on both BP’s.
I am participating in Cardiac Rehab with 30 minutes of aggressive treadmill and 30 minutes on a NuStep machine. Diastolic BP will drop from 60 into the low 40’s at the conclusion of 60 minute session and I’m concerned about this low a reading. Cardiologist doesn’t seem concerned but I have reservations about heart damage. I consider myself in fairly good condition and rigorously hike 4-7 miles frequently and am sure it must drop during these workouts in sometimes rugged terrain.
Are my concerns warranted?
Thank you so much for your comments.
We generally do not focus on the diastolic blood pressure (bottom number). In your case, a systolic blood pressure (top number) <130 mm Hg (even <125 mm Hg) would be desirable.
Enjoyed reading your article. I am a 66 year old woman who has been on numerous blood pressure meds since August 2019. I either had side effects or they didn’t lower my blood pressure. Got frustrated with my family doctor and went to a cardiologist. He said that in his line of work I am a boring patient because I am healthy. He put me on 40mg. Valsartan and after a week increased it to 80 mg. I started feeling lightheaded most days and sometimes it lasted all day. I switched up my dose taking 40mg in the am and 40mg in the pm but the lightheadness continued. I asked my doctor to switch me back to 5 mg Lisinopril since that had worked for 8 months. I have been on this for 10 days. I continue to be lightheaded only not as bad as when I was on the Valsartan and have tingling in my hands sometimes. My blood pressure is good – medium to high 120’s over mid to low 69’s with an occasional 59. I go to see my doctor next week and am really frustrated. I am active person but am tired of being lightheaded! I am thinking of switching to a product called Bloodsyl as it seems more of a natural product. What is your opinion?
I am not familiar with Bloodsyl, but in general, natural products are not tested rigorously for effectiveness. Your blood pressure seems pretty well controlled on a low dose of valsartan or lisinopril, and I wonder if either is required for your blood pressure. I would recommend discussing your concerns with your family doctor or cardiologist.
Hello Dr Guichard and thanks in advance for your consideration.
I’m an 81yr old with CHF..quadruple bypass 14 years ago. Diagnosed with CHF 3 years ago. I’m doing well, normal BP 163/62 in the morning, but after a 30 minute walk BP can fall to 75/ 48..very little dizziness..Meds Entresto 49-51..half twice daily..Torsemide 10mg..lanoxin .O25..warfarin 5mg..Rosuvastain 10mg..Cavedilol 6.O25 twice daily..COQ-10 100mg..Rivotril for NLS..
Also, Blood Pressure falls after meds and breakfast..
It sounds like you are being well-managed. For patients with low LVEF (<40%) heart failure, we generally prefer a systolic blood pressure of 100-110 mm Hg. It seems like you swing above and below this on a daily basis, so that is tricky to manage.
Glenn… forgot have pacemaker..heart rate stays at 60bpm also take 2.5mcg Tikosyn twice daily
How much effect do you see for life style changes in controlling blood pressure? I am 66 and have found that I can maintain my BP at 110/70 most of the time (I have a BP cuff) but it requires paying attention to what I eat and drink (especially limiting alcohol consumption) and exercising. A few months into the pandemic I realized I was drinking too much and not exercising enough. I dug out the BP cuff and discovered my BP was pretty consistently at 150/90 for several weeks. At that point I ramped the booze down and exercise up and BP came back to 110/70. Am I just lucky or is BP largely controllable through diet and exercise, etc?
Yes, blood pressure is largely controllable through diet, exercise, and weight loss. Congratulations to you for realizing that and working consistently to achieve that goal.
I’m 29 years old about 105 pounds hight 5’5 and my blood pressure has been upper 140’s over 85 is this normal I have no idea I feel light headed like something is off.
It’s been this way for almost 5 days
That is a little high for someone your age, but would monitor this over the next 2 weeks. If your blood pressure remains elevated, I would discuss this further with your primary care physician.
Doctor — I’ve researched extensively on cardiovacular issues on a wide range..
Since I found your site/blog , because I was suffering regular very low bp drops.
However, you covered about 20 other related issues I needed answers to but were not directly related.
Problems/situations/questions, These were not clear in years of research..
They should award you the Nobel prize or at least least the ACC headship..
Very clear , comprehensive & concise information.. Thank you
Thank you very much for the kind words.
Great article and even better replies . . . You suggest “combining both an ACEI and ARB is discouraged”, and I am wondering why.
75yo male hypertensive for decades and now for about six months experiencing episodes of hypertensive crisis >180 / <95 two or more time a month usually at rest sitting at my computer. I wait for the blurred vision b4 checking the BP.
lorsartan 100mg 1x and hydralazine 50mg 3x are the primary meds . For these excursions to 'crisis' a medical professional here in Mexico suggested captopril for use during 'crisis' events only.
My PCP(VA) is aware and has yet to offer any change to the med schedule. (are there not better class meds than lorsartan; i.e. Telmisartan?)
I welcome your opinion, please.
Thanks for being there
Yes, combining both an ACEI and ARB increases the risk of side effects including hyperkalemia and angioedema. Additional medications that I would attempt before adding captopril to lorsartan would be amlodipine and chlorthalidone.
Hi, I’m a soon to be 71 year old male and my blood pressure is between 90/52 or 105/56 only take an aspirin, 40 mg rosuvastatin and 50 mg of sertraline. Six months ago my blood pressure was 117/66. Is it too low now. I regularly swim and exercise. Eat a lot of salmon, berries, nuts and veggies. No alcohol, cigarettes.
No, that can be a normal blood pressure for you – especially since you are not on any high blood pressure medications and you appear to have excellent diet and exercise habits.
I’m Reynaldo Chaves 66 year of age, i have a low diastolic and my medication are amlodipine besylate 10mg ,lisinopril 20mg , losartan potassium and hydrochlorothiazide100mg ,carvedilol 12.5 mg ,rosuvastatin 40mg and also i take metformine for my diabetes. Do i have the right medicine that im taken?
Generally speaking, it is not recommended to be on lisinopril (angiotensin-converting-enzyme inhibitor) and losartan (angiotensin II receptor blocker) at the same time. Otherwise, based on your description, your medications appear more-or-less appropriate.
My recent visit to the ER, as a result of waking with chest discomfort, revealed an average BP of 100/50. I am a 53 year old female. I often have low diastolic readings, but never this low! I will be seeing a Cardiologist, this coming week.
In the meantime, could you shed any light on my low diastolic reading?
Thank you in advance. Sarah
It is difficult to say for sure, seeing a cardiologist based on your ER visit is definitely reasonable.
HI Doctor, I am delighted to see someone is take high BP seriously. I was diagnosed with HBP about 16 years ago. I am 67 now, I have had AFiB as well, after they were unable to get back into sync they decided to an oblation I have not had two of them.. My BP was always quite high and they had me on water pill, blood thinner, beta blocker, statin , I also use a CPAC.for sleeping as well. My weigh was a concern so I worked real hard to lose it. I went from 262 down to 170. I monitor my BP everyday twice a day. While my systolic has come down my diastolic numbers are very low on average it is below 50. Just took it 116/59 pulse62. My VA doctors have taken me off the water pill, the beta blocker, I am still on my blood thinner and statins My concern is my lower number as I am tired more, light headed sometimes. I have changed my eating habits, no drinking no smoking, exercise by walking 3-5 miles a day.
Do you have any suggestions. Thank you for taking the time to help. HBP is so hard to understand. I have done some serious research, your was the at least understandable thanks.
You have a phenomenon called isolated diastolic hypotension, defined as a systolic blood pressure ≥100 mm Hg and a diastolic blood pressure <60 mm Hg. If you are symptomatic (tired more, light headed sometimes - in your case), then stopping high blood pressure medications is reasonable to see if symptoms improve. Other than stop tobacco products, minimize alcohol, low salt diet, and exercise - there are not many known treatment options.
Thank you so very much for replying. I feel better now that I know there is not a lot left to do here. I guess the other question I have is as I am only 67 is there anything else I can do to help my situation. I would like to get to enjoy my senior years. Thank you I do really appreciate all your feedback. I only wish more Doctors were like you.. All the best sir..
Thank you for the information in this post. I’m a 72 year old. Male. I experienced
an ICH in November 2021, but suffered very little functional impairment. No definitive cause identified but the treating neurologist believes it was likely triggered by a spike n BP. At the time I was on a low dose of Lisinopril. Now I’m taking 50mg of Losartan with a goal of <140 systolic. Achieved as an average most days. But my diastolic usually is between 50 and 55 and often dips into the 40s. Should I be concerned about the diastolic being consistently less than 60 and, if so, what should I do to address the problem. MY primary physician focuses primarily on the diastolic reading. Thank you in advance for sharing your expertise.
There is not much to do for isolated diastolic hypotension. In general, we do follow the systolic blood pressure when monitoring hypertension. From what you are describing, it appears that your blood pressure is reasonably controlled at home.